Citation NR: 9713433
Decision Date: 04/18/97 Archive Date: 04/29/97
DOCKET NO. 94-47 831 ) DATE
)
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On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO) in
Pittsburgh, Pennsylvania
THE ISSUE
Entitlement to service connection for a psychiatric disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
J. Horrigan, Counsel
INTRODUCTION
The veteran served on active duty from July 1978 to February
1980. In June 1979, a special court martial sentenced the
veteran to receive a bad conduct discharge which was
subsequently upgraded to a general discharge by order of the
Secretary of the Army.
The RO denied service connection for a mental disorder in a
rating decision of March 1992. He did not file a timely
Notice of Disagreement with that determination. In November
1993, the veteran applied to reopen his claim of service
connection for a psychiatric disability. This matter comes
before the Board of Veterans' Appeals (Board) from an August
1994 rating action that denied service connection for
schizophrenia. In that rating decision, the RO considered
all the evidence of record thus apparently finding that new
and material evidence had been submitted to reopen the
veteran's claim of service connection for a psychiatric
disability. The Board will therefore consider this issue on
a de novo at this time.
CONTENTIONS OF APPELLANT ON APPEAL
It is essentially contended, by and on behalf of the veteran,
that he developed a chronic psychiatric disorder while
serving on active duty.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1996), has reviewed and considered
all the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the evidence is in favor of
the grant of service connection for a psychiatric disorder.
FINDING OF FACT
The veteran's current psychiatric disorder, diagnosed as
chronic paranoid schizophrenia, had its onset during service.
CONCLUSION OF LAW
Paranoid schizophrenia was incurred during service.
38 U.S.C.A. §§ 1131, 5107(a) (West & Supp. 1996); 38 C.F.R.
§ 3.303 (1996).
REASONS AND BASES FOR FINDING AND CONCLUSION
I. Factual Background
The veteran served on active duty from July 1978 to February
1980.
On examination prior to entrance onto active duty, the
veteran was evaluated as psychiatrically normal. Review of
the service medical records reveals that the veteran was seen
in late June 1979 at the confinement facility of a military
hospital after he reported to sick call apparently feeling
that he was requested to appear, which he was not. The
veteran's behavior and verbal comment was somewhat bizarre.
The guards stated that the veteran talked with inanimate
objects and responded strangely to verbal commands as if he
were somewhere else.
In a request for a consultation dated in late June 1979, it
was noted that the veteran was behaving strangely and
appeared to have no idea of what the guards were talking to
him about. Talking with inanimate objects and generally
bizarre behavior were also reported. When again seen in late
June 1979, it was noted that the veteran appeared suspicious
and somewhat passive. He was oriented times three and had
some ideation of self-harm. Further evaluation was
recommended.
During a hospitalization at a military facility from late
June to early July 1979, it was noted that the veteran had
been court-martialed and subsequently sent to the U.S.
Detention Barracks upon being convicted and sentenced.
Bizarre behavior was documented when the veteran was being
inprocessed. The behavior consisted of confusion,
disorientation, perplexity, auditory hallucinations, and
rather global paranoid ideation. When seen initially, the
veteran was making serpentine movements and crawling across
the floor from his mattress to the door and back again. On
entering the room, the veteran was noted to be standing in
the corner as though he were urinating. His speech was a
rather hushed monotone with some indications of blocking. He
admitted to auditory hallucinations which consisted of voices
telling him to "shut up." He also admitted to questionable
visual hallucinations and a number of paranoid delusions to
include fear that people who had been executed would come
back to haunt him or hurt him. He also maintained paranoid
delusions in the past and at the present time that his food
was poisoned. He also entertained the delusion that he had
syphilis and that his mother had syphilis. At time of
transfer to another military hospital, the diagnosis was
schizophrenic episode, paranoid type, acute, severe,
manifested by blunted, constricted affect, delusions,
hallucinations, paranoid ideation, and intermittent
grandiosity.
During further hospitalization at a military facility from
early July to early August 1979, the veteran related his
difficulties to a homosexual attack that occurred when he was
in the stockade at Fort Knox. Since that time, he had been
tortured by voices making reference to him as a homosexual
and also heard his father's voice. He had developed
delusional fears stating that he had syphilis and that his
penis was collapsing. He also felt that his life was in
danger at Fort Knox. Mental status evaluation revealed the
veteran to be quiet, and cooperative. He demonstrated no
unusual mannerisms or bizarre behavior during the interview.
His thoughts were clear, logical, and goal-directed. There
was no evidence of tangentiality or blocking. His base mood
was level but his affected responses were blunted in
intensity, and not inappropriate in character. Although the
veteran acknowledged hallucinatory activity, there was no
evidence of this during the interview. The veteran remained
delusional to the extent of having multiple somatic
preoccupations and a general conviction that he was in poor
health and likely to die. His sensorium was intact with
orientation in all three spheres, good recent and remote
memory, adequate attention span and concentration, and
general fund of information. The veteran was able to perform
calculations satisfactorily, although he could not think
abstractly and his judgment was fair to poor in most tested
areas. Intellect was felt to be approaching average and he
showed little or more insight into the nature of his current
dysfunction. During the hospitalization, the veteran was
placed on Haldol and showed immediate improvement. He was
given several medical consultations for somatic concerns and
about that time he reported subjective improvement in
hallucinatory activity and also an amelioration of delusional
fears. At the time of discharge, the diagnosis was
schizophrenia, paranoid type, chronic, severe; manifested by
auditory hallucinations, multiple paranoid delusions and
somatic preoccupations.
The veteran was again hospitalized at a military facility
from early August to late September 1979. He was placed on a
closed ward with a diagnosis of acute schizophrenic episode.
He was continued on Haldol but suffered several hypostatic
episodes and was switched to Thorazine. With both drugs, it
was noted that the veteran showed progressive reconstitution
so that by the end of approximately four weeks the Thorazine
was slowly tapered and discontinued. At the time of
discharge, there was no evidence of a psychosis. The final
diagnosis was acute schizophrenic episode. On examination
prior to separation from service in September 1979, it was
noted that the veteran was recovering from an acute
schizophrenic episode.
Medical records from a State correctional institution
revealed that the veteran was seen in February 1986 and noted
to be very withdrawn. He was reported to be on Thorazine.
In mid-March 1986, it was noted that the veteran was refusing
to eat or talk. In early April 1986, the veteran was noted
to refuse all meals and was lying on the floor for several
hours at a time. At times he sat on the floor with a sheet
over his head. There were no verbal responses. In mid-April
1986, the veteran was noted to be on suicide watch.
Additional clinical records reflect treatment a State
correctional institution in 1992 and 1993 for symptoms which
included depression, paranoia, suicidal ideation,
hallucinations, delusions and agitation. After a psychiatric
assessment in October 1993, the diagnosis was schizophrenia,
paranoid type, in remission.
On VA examination in August 1994, the veteran gave a history
of getting into a fight in mid-1979, during service. After
this episode he was awaiting court-martial, and became
psychiatrically ill. The veteran reported that at the time
he had very strong paranoid feelings, delusions of
persecution, auditory hallucinations, agitation and sleeping
difficulties. He also reported severe depression with
suicidal ideation. Since his discharge from the service in
1980, the veteran spent the bulk of his life in jail.
On evaluation, the veteran was alert, fully oriented, and in
reasonably good contact with routine aspects of reality.
There were no active signs of psychosis. He spoke in a
rather slow and monotonal manner but nevertheless exhibited
goal-directed and organized thinking. He did not espouse any
delusional ideation and he did not appear to be responding to
his hallucinations at the present time. His mood was one of
reported moderate depression which he felt was reasonably
well controlled with medication. His affect was extremely
blunted and flat. Intellect and memory appeared to be
generally intact, although slightly below-average capacity on
psychological testing. The veteran presented himself as a
rather well-reconstituted schizophrenic person with paranoid
tendencies, delusions and hallucinations who is currently
being reasonably well managed on medication. The overall
clinical impression was one of a chronic paranoid
schizophrenia which did, indeed, begin while the veteran was
in service and which had continued since that time. This was
a chronic condition which had sprinkled with episodes of
greater acuity over the course of time. Likewise apparent
was a probable antisocial personality disorder that was very
virulent when the veteran was actively psychotic and fed into
by paranoid thoughts and delusions. The diagnosis on Axis I
was schizophrenia, chronic, paranoid type, currently in
decent remission. Polysubstance abuse, by history, currently
in reported remission was also diagnosed on Axis I. An
antisocial personality disorder was diagnosed on Axis II.
II. Analysis
Initially, it is found that the veteran's claim of service
connection for a psychiatric disability is well grounded
within the meaning of 38 U.S.C.A. § 5107(a). That is, the
Board finds that the veteran has submitted a claim which is
plausible. All relevant facts pertaining to this claim have
been developed, and no further assistance to the veteran is
required in order to satisfy the VA's duty to assist him in
the development of his claim as mandated by 38 U.S.C.A.
§ 5107(a).
The veteran’s DD Form 214 notes that the period from June 15,
to September 23, 1979 was time lost under 10 U.S.C.§ 972 The
record indicates that the veteran was incarcerated during
this period after conviction by a special court martial.
However, while the veteran was also sentenced to receive a
bad conduct discharge by this proceeding, his discharge was
subsequently upgraded to a general discharge under honorable
conditions. Consequently, the provisions of 38 U.S.C.A. §
105(b)(2) (1996) are not for application in this case since
the veteran was not confined under sentence of court martial
involving an unremitted dishonorable discharge. Accordingly,
the Board will consider the question of the chronicity of the
veteran’s inservice psychiatric disorder and not whether the
veteran’s inservice psychiatric symptoms were the initial
manifestations of his current psychosis.
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by peacetime
service. 38 U.S.C.A. § 1131.
The veteran's service medical records reveal considerable
treatment while on active duty for psychiatric symptomatology
which included bizarre behavior, auditory hallucinations, and
multiple paranoid delusions. After two hospitalizations at
military facilities from June to August 1979, the diagnosis
of chronic paranoid schizophrenia was rendered. Following a
third inservice hospitalization for psychiatric
symptomatology, it was noted that the veteran showed
progressive reconstitution on Thorazine and a diagnosis of
acute schizophrenic episode was rendered. Post service
clinical records reflect treatment at State correctional
facilities for psychiatric symptoms beginning in the
mid-1980's. Following a VA examination in August 1994, the
diagnoses included chronic paranoid-type schizophrenia,
currently in decent remission. The examiner opined that this
disorder began during service.
While on active duty the veteran clearly demonstrated
considerable symptomatology, such as delusions and auditory
hallucinations, which is indicative of an active psychotic
process and were abated with the use of psychotropic
medications such as Haldol and Thorazine. While acute
schizophrenia was diagnosed at the end of the veteran's
period of service, subsequent post service clinical records
indicate that the veteran's symptomatology has been
continuing. Moreover, after the veteran's most recent VA
psychiatric examination in August 1994, the examiner opined
that the veteran's chronic paranoid schizophrenia did indeed
begin while he was in the service and had continued since
that time. Since the evidence of record indicates that the
veteran's current psychiatric symptomatology had its onset
during service, service connection for a psychiatric
disability, currently diagnosed as chronic paranoid
schizophrenia, is warranted.
ORDER
Service connection for a psychiatric disorder is granted.
BRUCE E. HYMAN
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1995), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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